India, China account for one-third of world’s bad cholesterol burden: Global study
New Delhi: A silent health crisis is unfolding across Asia, and it is far deadlier than many realise. While infectious diseases often dominate public health discussions, a new global analysis has revealed that elevated low-density lipoprotein cholesterol (LDL-C), commonly known as “bad” cholesterol, is quietly fuelling millions of deaths worldwide. Alarmingly, India and China together account for nearly one-third of the global disease burden linked to high LDL cholesterol, underscoring the immense cardiovascular challenge facing the world’s two most populous nations. The findings come at a time when both countries are grappling with rapidly ageing populations, changing lifestyles and a growing epidemic of non-communicable diseases.
India and China account for one-third of the global LDL cholesterol burden
The findings, published in the Journal of the American Medical Association (JAMA) as part of the Global Burden of Disease (GBD) 2023 study, estimate that elevated LDL cholesterol caused 3.6 million deaths worldwide in 2023, accounting for around 6 per cent of all deaths globally. It was also responsible for 8.1 per cent of all deaths from non-communicable diseases (NCDs) and nearly 18.9 per cent of cardiovascular disease deaths.
Researchers found that India and China together accounted for approximately 34 per cent of all disability-adjusted life years (DALYs) attributable to high LDL cholesterol, representing the largest concentration of cholesterol-related disease burden anywhere in the world.
What is LDL cholesterol and why is it dangerous
Low-density lipoprotein (LDL) cholesterol is often referred to as “bad” cholesterol because excess LDL can accumulate inside artery walls, forming plaques that narrow blood vessels – a process known as atherosclerosis.
Over time, this significantly raises the risk of:
- Heart attacks
- Ischaemic heart disease
- Ischaemic stroke
- Peripheral artery disease
Unlike many other health conditions, high LDL cholesterol usually develops without noticeable symptoms, earning it the reputation of being a “silent killer.”
Cardiovascular diseases remain the biggest threat
The study highlights the enormous role high LDL cholesterol continues to play in cardiovascular deaths globally.
Researchers estimated that in 2023, elevated LDL cholesterol contributed to:
- Around 2.7 million deaths from ischaemic heart disease, accounting for nearly one-third of all such deaths.
- Nearly 870,000 deaths from ischaemic stroke, representing about 27 per cent of stroke deaths worldwide.
These findings reinforce decades of evidence linking uncontrolled cholesterol levels to preventable cardiovascular disease.
Why are India and China carrying such massive burden
The researchers say the growing burden is being driven by multiple demographic and lifestyle factors rather than a single cause.
Key contributors include:
- Rapid population growth
- Ageing populations
- Urbanisation
- Sedentary lifestyles
- Diets increasingly rich in saturated fats and ultra-processed foods
- Rising obesity and diabetes rates
- Gaps in early diagnosis and long-term cholesterol management
The study also notes that although age-standardised disease rates have improved in several regions over the past three decades, the absolute number of people affected continues to rise because more people are living longer, particularly in middle-income countries.
Global burden has risen sharply since 1990
According to the GBD analysis, the number of adults living with elevated LDL cholesterol has increased substantially since 1990.
While medical advances and preventive strategies have reduced age-adjusted risks in many high-income nations, population growth and ageing have offset these gains globally, resulting in a larger overall disease burden. Researchers also observed that the burden has increasingly shifted towards middle socio-demographic regions, including countries like India.
Treatment exists; but access and awareness remain major hurdles
Experts emphasise that elevated LDL cholesterol is among the most treatable cardiovascular risk factors.
Statins remain the cornerstone of therapy and have consistently been shown to lower LDL cholesterol and reduce the risk of heart attacks and strokes. Other therapies, including ezetimibe and newer PCSK9 inhibitors, are available for patients who require additional cholesterol reduction.
However, the study points out that many people worldwide either remain undiagnosed, receive inadequate treatment or discontinue medications, particularly in low- and middle-income countries where access to screening and long-term care remains uneven. Strengthening primary healthcare systems, expanding cholesterol screening and improving access to affordable medicines are therefore critical to reducing future cardiovascular deaths.
Wake-up call for India
India is already witnessing a rapid rise in non-communicable diseases, with cardiovascular disease remaining the country’s leading cause of death. The latest findings suggest that addressing high LDL cholesterol must become a central public health priority alongside diabetes, hypertension and obesity.
Public health experts argue that greater awareness, routine lipid screening, healthier diets, increased physical activity, tobacco control and timely medical treatment could substantially reduce the country’s future cardiovascular burden.
As India continues to urbanise and its population ages, the study serves as a stark reminder that one of the world’s biggest health threats is also one of its most preventable.